Sr. Payer Contracts Analyst

Managed Care & Payer Relations  
Full Time
Day Shift 
8

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina and the first hospital in the state to achieve Magnet with Distinction status for excellence in nursing care.

The 607-bed teaching hospital anchors a health care network that includes six community medical centers and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices.  Its postgraduate medical education programs include family medicine and transitional year.

 

 

 

 

Job Summary

Coordinate the loading, validation and maintenance of payer reimbursement rates in hospital electronic health record (EHR) System (Currently EPIC HB and EPIC PB). Coordinate and assist with the timely administration all functions related to the Managed Care & Payer Relations Department’s contract management system (Payment Integrity Compass) and provide reports and analytical support related to managed care reimbursement as needed. 

Minimum Qualifications

Minimum Education: Bachelor's Degree in Computer Science, Management Science, Business, or related field 
Minimum Years of Experience: 3 years of experience in managed care finance
Substitutable Education & Experience (Optional): Consideration will be given to candidates with an Associate's Degree in Computer Science, Management Science, Business, or related field and 5 years of experience in managed care finance or candidates with a High School Diploma and 8 years of experience in Managed Care Finance
Required Certifications/Licensure: Epic Resolute PB and HB certification required or must obtain both within 18 months of hire
Required Training: Working knowledge of managed care reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC);

Working knowledge of billing/coding terminology (i.e. ICD-10, CPT, Revenue codes);

Procedural knowledge of hospital and physician practice accounts receivable management;

Working knowledge of PC-ad hoc report writers and query language
 

Essential Functions

• Maintain data files of all payer reimbursement rates and rules on hospital shared drives
• Coordinate and interact with Information Services to load and maintain payer reimbursement rates and rules to hospital EHR Systems (currently EPIC) for all hospital, ancillary and physician network services.
• Validate and ensure complete accuracy of the load and set up of all payer reimbursement rates to hospital EHR Systems
• Develop and implement strategy to resolve problems or limitations to EPIC payer reimbursement rate set up with Information Services and/or hospital EHR Systems vendor.
• Function as a primary resource for questions related to payer reimbursement rates and rules for all hospital, ancillary and physician network services.
• Develop Policies and Procedures to support system payer reimbursement rate implementations and workflows driven by these.
• Collaborate with end users, business areas, IT, vendors and leadership to develop, elicit, analyze, communicate, and validate system processes based on payer reimbursement rate information. 

Duties & Responsibilities

• Provide ongoing user support and training, when applicable, paying keen attention to user needs and opportunities to offer solutions and modify processes to improve related efficiencies.
• Assist Manager and Director in contract modeling and analysis of proposed reimbursement rates and other financial terms.
• Conduct service line managed care reimbursement analysis as requested by Management.
• Develop and maintain weekly, monthly and ad hoc financial performance reports as needed from both EPIC and Department’s contract management system.
• Function as a team lead regarding maintenance of all payer reimbursement rates within Department’s contract management system and all workflows, financial models and reports based on these.
• ther duties as assigned.

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